Hiqa finds major non-compliance at Raheny home operated by Beaumont Hospital

Allegations of abuse at the Raheny Community Nursing Unit were received by Hiqa. Photograph: Bryan O’Brien

Elderly residents were physically restrained by staff during their personal care and in some cases were “rushed” through breakfast while sitting in soiled incontinence wear at a community nursing home operated by Beaumont Hospital.

The Health Information and Quality Authority (Hiqa) carried out an unannounced inspection at the Raheny Community Nursing Unit in October after it received allegations of abuse by staff.

The staff against whom the allegations were made was a mix of nurses and carers.

The inspection found major areas of non compliance with nursing home regulations, including a lack of management oversight and “poor leadership, direction and risk management”.

There were 96 residents in the home on the day of the inspection.

The nursing home had put in place specific measures after an allegation of abuse was received by Hiqa on August 25th last, the inspection report said.

This included putting an additional clinical nurse manager on duty at night to supervise staff.

All staff against whom allegations had been made were also limited to day duties and not permitted to work unsupervised until further notice. However, Hiqa said that on the day of its inspection it found evidence that these measures were not being implemented in full.

Inspectors said the use of restraint was “not excessive” and where it was used, it was, for the most part, regularly reviewed. The primary types of restraints used were bed rails, lap belts and medications.

However, inspectors also found instances where limitations of residents’ freedom through “physical holding during personal care interventions were used”.

Hiqa said indefinite restraint orders must not be used.

“Physical restraint is used only as an emergency measure when unanticipated behaviour can place the resident in immediate danger.”

Feedback from residents and their relatives on the level of consultation with them and access to meaningful activities was “very positive”, Hiqa acknowledged.

“All those spoken to praised the staff for the cheerful and respectful manner in which they delivered care. Most residents spoken with said staff were very helpful and quick to respond to their needs, but some residents said they sometimes had to wait for staff to assist them to get washed and dressed.”

Inspectors observed that the assistance provided to residents during the breakfast service to be particularly rushed and some residents “were assisted to eat their breakfast, prior to their soiled incontinence wear being changed”.

Hiqa said a plan submitted by the provider to deal with the concerns about restraint practices was not acceptable, as it did not satisfactorily address all of the failings identified.

In relation to the allegations of abuse, the provider said it had put in place a policy to ensure an alleged incident was reported on the day of occurrence and that gardaí were also informed the same day.

Hiqa published 14 inspection reports on residential centres for older people examined for compliance with the Health Act 2007 and regulations governing nursing homes.

Inspectors found evidence of good practice and compliance with the regulations and standards was found in seven centres. Evidence of non-compliance was found in another seven.

At Patterson’s Nursing Home, Lismackin, Roscrea, Co Tipperary, Hiqa inspectors found the system in place to manage residents’ finances “was not sufficiently robust to protect residents or staff”.

Sums of money were being held in the nursing home account for a number of residents and not in a separate resident account.

“This system did not facilitate residents to accumulate interest on their savings and their finances were not fully protected,” the report said.